Safety and efficacy of brimonidine in children with glaucoma

Purpose: Brimonidine is a relatively selective (x-agonist, which reduces in traocular pressure (IOP) by decreasing aqueous production and increasing uv eoscleral outflow. Brimonidine passes through the blood-brain barrier, pote ntially causing central nervous system (CNS) toxicity. There have been repo rts of bradycardia, hypotension, hypothermia, hypotonia, and apnea in infan ts after topical brimonidine. Methods: We reviewed the IOP data and side ef fects of children at the Duke University Eye Center placed on brimonidine f rom June 1997 to October 2000. Brimonidine 0.2% was used for patients whose glaucoma was uncontrolled on maximal tolerated medical therapy. A monocula r trial was performed whenever possible, and brimonidine was not prescribed for infants. Included were 32 eyes of 30 patients with uncontrolled IOP an d varied glaucoma diagnoses. Results: The mean patient age was 10.5 years, with a mean follow-up on brimonidine of 10.8 months. Most patients were on other glaucoma medications. In 11 of the 32 eyes the IOP data could be inte rpreted, and in these eyes the IOP decreased from a mean of 22.5 +/- 4.9 mm Hg to a mean of 20.8 +/- 4.0 mm Hg (a mean decrease of 6.7% +/- 10%, P = . 04) on brimonidine after a mean follow-up of 11.0 +/- 6.9 months. Two young children (ages 2.4 and 3.7 years) repeatedly were unarousable soon after t he administration of brimonidine. Five other children experienced extreme f atigue after brimonidine administration. All symptoms resolved after brimon idine was discontinued. Discussion/Conclusions: Brimonidine should be used with caution in young children because of the potential for CNS depression. In selected patients, brimonidine has a substantial ocular hypotensive eff ect.